HomeMy WebLinkAboutApplication A AndersonThe City of Port Angeles
Advisorv Board Application
RECEIVED
FEB 2 q 20m
CITY OF PORT ANGELES
CITY CLERK
Parks, Recreation and Beautification Commission
Applicant Name and General Information
First MI Last
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Address City J State Zip
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Homephone Work phone
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Cell phone
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E-mail address ._J
Certification and Location Information
Are you employed by the City of Port Angeles?........................
ArE you a Registered Voter?---
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No
No
No
Yes
Yes
Yes
Yes
Ifso, how long
Do you otrr/manage a business in the City?....................
Do you hold any professional licenses, registrdtions or certificates in any field2 -it)*.E.A.E ,/-aAa
Yes
Yes
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No
Ifso, please list:
Are you aware ofany conflict of interest which might arise by your service on the advisory board that you are applying for?
Ifso, please explain:
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The City of Port Angeles
Advisory Board Annlication
Work or Professional Experience - List most recent experience first, or attach a resume
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Employer
Briefjob description
Employer
Briefjob ription
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Empl
Briefjob on
Education - List most recent experience first 4J1 vir, Otaaa/ at \ttUJ I .r-z-2, <A ) ,, a
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Institution/Location
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Degree eamed./Major area of Study Graduated?
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lnstitution/Location
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Degree eamed/Major area of Study Graduated?
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;;il,vL;A,i*D.c,*A.d/G;;m,,dy Graduated?
Charitable, Social and Civic Activities and Memberships - List major activities you have participated in
during the last five years
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Organizati or/ Location
Brief description of your participation
Brief description of your participation
Group's purpose/obj ecti veOrganizatior/Location
The City of Port Angeles
Advisorv Board Annlication
Parks, Recreation and Beatification Commission Applicant Supplemental Questionnaire
l. This Commission focuses on three areas: parks, recreation, and beautification. Ifyou had to choose, which ofthese $ree areas
would be the primary one in which your interests and experience would be aimed?
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2. What is your favorite City of Port Angeles
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love about this park?
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and why?
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have done. to rmprove yo
of
? What do you
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Applicant Signature
Submit completed forms to:OIfice of the City Clerk
City of Port Angeles
321 East 5d Street
Port Angeles, WA 98362
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Date
Kari Martinez-Bailey
3604't74634
kmbailey@cityofpa.us
In compliance with the Americans with Disabilities Act, ifyou need special accommodations because ofa physical limitation,
please contact the Ciry Manager's Office at 360-41 7-4500 so appropriate arrangements can be made.
This document and all anached information is considered a public record and may be distributed to members ofthe City
Council for appointment consideration. Additionally, it may become a part ofa City Council packet.